复合手术治疗颅内复杂破裂动脉瘤的效果分析

发布时间：2018-03-14 07:09

本文选题：颅内动脉瘤　切入点：颅内出血　出处：《中国脑血管病杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨应用复合手术治疗颅内复杂破裂动脉瘤的安全性及短期有效性。方法回顾性连续纳入2014年12月至2017年3月南方医科大学南方医院神经外科行复合手术治疗的复杂破裂动脉瘤患者14例,其中急性自发性蛛网膜下腔出血性动脉瘤13例,复发动脉瘤栓塞术中出血1例。12例动脉瘤行塑形夹闭术,术中均行DSA造影评估动脉瘤夹闭效果。2例动脉瘤行颅内外血管旁路移植并动脉瘤孤立术,DSA造影评估桥血管通畅性后行血管内球囊闭塞术孤立动脉瘤。结果 14例患者,11例造影后急诊行复合手术,2例择期手术,1例栓塞术中出血急诊行抢救性手术。12例动脉瘤夹闭术中造影提示3例需要调整动脉瘤夹,其中2例载瘤动脉狭窄,1例夹闭不全,调整后均夹闭满意。2例颅内外血管旁路移植术中造影均通畅,一期行动脉瘤孤立术。术后1例患者因严重血管痉挛,自动出院。1例术后出现灌注压突破,行血肿清除并减压术,出院时格拉斯哥预后评分(GOS)3分。余患者术后均无新发神经功能障碍。对13例患者术后3~24个月行临床随访,均无新发神经功能障碍,GOS 5分8例,4分5例。6例患者行DSA复查,其中4例动脉瘤夹闭未见动脉瘤复发,载瘤动脉通畅;2例血管旁路移植动脉瘤无复发,载瘤动脉及吻合血管通畅。结论初步观察,应用复合手术方式治疗颅内复杂破裂动脉瘤安全且有效。
[Abstract]:Objective to evaluate the safety and short-term efficacy of combined surgery in the treatment of complicated ruptured intracranial aneurysms. Methods from December 2014 to March 2017, a series of neurosurgical procedures were performed in the Department of Neurosurgery, Southern Hospital of Southern Medical University. 14 patients with complicated ruptured aneurysms, Among them, 13 cases of acute spontaneous subarachnoid hemorrhage aneurysm, 1 case of recurrent aneurysm hemorrhage during embolization, 12 cases of aneurysm underwent plastic clipping. Intraoperative DSA angiography was performed to evaluate the clipping effect of aneurysms. 2 cases of aneurysms underwent intracranial and external vascular bypass grafting and aneurysm isolation. Results 14 cases were treated with endovascular balloon occlusion of solitary aneurysms after the evaluation of graft patency. 11 patients underwent emergency combined operation after angiography, 2 patients underwent selective operation and 1 patient underwent emergency rescue operation during embolization operation. Among 12 cases of aneurysm clipping, 3 cases needed to adjust the aneurysm clamp. Among them, 2 cases with aneurysm stenosis and 1 case with incomplete clipping, and 2 cases with satisfactory occlusion after adjustment, were all patency in the course of extracranial and intracranial vascular bypass grafting, and one patient was treated with isolated aneurysm in one stage, and 1 patient had severe vasospasm after operation, and 1 case had severe vasospasm after operation. One patient was discharged from hospital automatically with a breakthrough of perfusion pressure, hematoma clearance and decompression, and a Glasgow prognosis score (GOS) of 3 at discharge. There were no new neurological disorders in the remaining patients. 13 patients were followed up 3 ~ 24 months after operation. No new neurological dysfunction was found in 8 cases, 5 cases in 4 cases underwent DSA reexamination, 4 cases had no recurrence in aneurysm clipping, and 2 cases had no recurrent aneurysm after aneurysm clipping. Conclusion the combined operation is safe and effective in the treatment of complicated ruptured intracranial aneurysms.
【作者单位】：南方医科大学南方医院神经外科;南方医科大学南方医院手术室;
【分类号】：R651.12

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